1. Field of the Invention
The present invention generally relates to computer databases used to store electronic records. More specifically, the present invention relates to managing the accessibility of electronic healthcare records in a distributed domain.
2. Description of the Related Art
When an individual visits a physician, hospital, or clinic, numerous records related to the visit may be created. Records such as lab results, x-rays and other images, prescriptions, and notes regarding treatment decisions, provide a few common examples of records that may be created as a result of a treatment encounter between a patient and a physician. Such records also often reflect the diagnosis of some disease or condition along with a prescribed course of treatment. Historically, the records related to a particular individual or treatment encounter have been maintained by the provider responsible for creating the record. For example, an individual's primary care physician typically maintains any records related to treatment encounters between the individual and the primary care physician. Thus, when an individual visits the primary care physician for an annual physical exam, the records related to the exam are created and stored at the office of the primary care physician. Similarly, if an individual receives care at an emergency room, the attendant hospital has historically maintained records of the care provided at the emergency room.
Like records maintained for virtually every other profession, healthcare records have begun to migrate from paper to electronic forms, and computer databases are frequently used to store electronic healthcare records. Computer databases are well known systems used to store, maintain, and retrieve data. Generally, a database is a collection of data that is organized in a manner to allow its contents to be easily accessed, managed, and updated. The most prevalent type of database used today is the relational database, which organizes data using tables, and relationships between tables. For example, the DB2® family of RDBMS products (relational database management system) available from International Business Machines (IBM) provides a sophisticated commercial implementation of a relational database.
As more and more health care providers are turning to computer databases and practice management applications to create, store, and manage patient data, the ability of providers to share electronic records with one another has become increasingly viable. Accordingly, a great deal of interest has been focused on creating regional, national, and even global networks of shared access to electronic healthcare records, and many initiatives and pilots programs are either underway or being considered. The general goal of these projects is to provide a physician rendering treatment with access to all of the relevant electronic records for a patient, regardless of the location of the records or the healthcare provider involved in treatment.
A number of network models have been proposed to use in providing physicians with shared access to healthcare records. At one end of the spectrum is a fully centralized approach where the data records for a group of providers is stored using a data warehouse model. In a data warehouse model, data records created by many providers are stored in a centralized data center that may accessed by each of the providers. An advantage of this approach is that the data center may be optimized to meet specific quality of service targets (e.g. performance, availability, backup/recovery). At the same time, however, this model requires broad agreement among providers that all data records will be managed by a central authority; a requirement that may not be practical for electronic healthcare records. For example, issues over privacy concerns may prevent deployment of a single, nationwide electronic health record warehouse. Moreover, the scaling and reliability issues associated with a single warehouse approach are daunting. Consider, for example, how large such a warehouse would be that would contain all healthcare records for all citizens in a country as large as the United States.
At the other end of the spectrum is a fully distributed or federated approach. A federated model integrates multiple, heterogeneous, data sources. This approach allows each provider to access records distributed across multiple database management systems as though they were stored locally at the provider. Using this approach, electronic records regarding a given patent patient may be assembled on demand to provide a complete healthcare history of the individual. However, one drawback to using a fully federated model is that users may experience inconsistent quality of service levels provided by the diverse set of data sources. Moreover, many providers may be unwilling (or unable) to manage a local infrastructure with reasonable quality of service levels. Thus, issues such as partial failures due to network connectivity and/or (un)scheduled down time may prevent a fully federated approach from being a workable approach to sharing access to electronic healthcare records.
In between these extremes are hybrid approaches where some records may be centralized across local, state, or even national boundaries and others are stored in distributed or federated data stores. When new records are created, they may be stored in either a centralized or a local data store; however, problems may arise in deciding whether to store a particular record in a centralized or local data store. Moreover, the relative importance of a particular electronic healthcare record may change with the occurrence of contemporaneous events. Accordingly, there remains a need for techniques to manage electronic healthcare records stored using a hybrid approach; one that leverages the advantages of a centralized warehouse and the high-availability services it may provide, while still allowing at least some portion of the electronic records to remain federated across a number of distributed data nodes.